Skip to main content

Full text of "Galen's "Advice for an epileptic boy""

See other formats



* mSr y I 


A??^^ 


TEMKIN, 0. 

Galen's "Advice 
Epileptic Boy." 


for an 
193U 


. 




$P 


6$ 



SSp 



A. 







3*^ 


|. " 


/I* 


ftnp^H 




r/W \ , 






i>^L ] 




sL 


& Mi I 






YALE 
MEDICAL LIBRARY 




HISTORICAL 
LIBRARY 



COLLECTION OF 



CCUa^^i <°l &bJU± 







CrOhet; a. C. RLE. 



from: 
date: 



TEXTS AND DOCUMENTS 
GALEN'S "ADVICE FOR AN EPILEPTIC BOY" 



&j*/*v ^*J<u.lttt 



Translated from the Greek by OWSEI TEMKIN 



Reprinted from Bulletin of the Institute of the History of Medicine, Vol. II, 
No. 3, pp. 179-189, May, 1934. (Supplement to the Bulletin of the Johns Hopkins 
Hospital. Vol. LIV, No. 5, May, 1934) 



Reprinted from Bulletin of the Institute of the History of Medicine, Vol. II, 
No. 3, pp. 179-189, May, 1934. (Supplement to the Bulletin of the Johns Hopkins 
Hospital, Vol. LIV, No. 5, May, 1934) 



TEXTS AND DOCUMENTS 
GALEN'S "ADVICE FOR AN EPILEPTIC BOY" 

Translated from the Greek by OWSEI TEMKIN 

The "Advice for an Epileptic Boy" was, according to Ilberg, a letter written by 
Galen not earlier than 190 A.D., 1 a work, therefore, of the latter part of his life. 
We know no details about Caecilianus, the father of the sick boy, to whom the 
letter is addressed nor about Dionysius, the physician, mentioned in it. Since it 
serves practical purposes only, Galen's theoretical views on epilepsy are not 
explained, although to a large extent they form the scientific basis of his prescrip- 
tions. It may, however, be sufficient here to indicate that, according to Galen, 
epilepsy has its cause in the brain. When a thick phlegmatic humour assembles 
in its cavities, affecting the roots of the nerves and preventing the free passage of 
the psychic pneuma (an air-like substance supposed to effect the higher functions 
of the body) , the phenomena of epilepsy follow. The disease may either have its 
origin in the brain directly or the latter may be affected from the stomach or any 
part of the body. 2 

Apart from the older Latin translations, a German 3 and an Italian 4 translation 
have been published in this century. This, together with the fact that the text 
of the Kuehn edition which I have followed 6 is far from satisfactory, made me 
doubtful about the value of my enterprise. But the renewed interest in the dietetic 
treatment of epilepsy may perhaps justify this attempt, since to the best of my 
knowledge the little work has never been translated into English. 

1 Cf. J. Ilberg, Ueber die Schriftstellerei des Klaudios Galenos III (Rheinisches 
Museum 51, 1896, p. 183/184). 

2 Cf. Galen, De locis affectis III, Chapters 9-11. Cf. also A. J. Brock, Greek 
Medicine, London and Toronto, 1929, p. 220-225; and yon Storch, An Essay on 
the History of Epilepsy. Annals of Medical History, New Series, Vol. II, 1930, 
pp. 614-650. 

3 F. Heller, Ueber Pathologie und Therapie der Epilepsie im Altertum, Janus, 
16, 1911, p. 589-605. 

4 Augusto Botto-Micca, II "De puero epileptico" di Galeno. Rivista di Storia 
delle Scienze Mediche e Naturali. Anno 21, Vol. 12, 1930, p. 149-169. 

6 Claudii Galeni opera omnia, ed. C. G. Kiihn, Vol. XI (Lipsiae 1826) p. 357- 
378. I wish here to express my gratitude to Dr. Edelstein who gave me valuable 
advice and to my wife, Mrs. C. L. Temkin who corrected my English. 

179 



180 OWSEI TEMKIN 

Dear Caecilianus, 

I thought you would not need our advice for your boy's disease. 
Dionysius has already seen him and is about to sail back to Athens 
together with you. He is competent to do what is necessary while 
he is present, and to give new instructions according to the condition 
of the disease, when he leaves. I, however, who have never seen the 
boy might perhaps err very much since I was not acquainted with his 
original nature, and do not know how it has been affected by the 
disease. All I heard from you is that he suffers from epileptic par- 
oxysms. 

Now you probably think that negligence rather than the desire for 
truth makes me evade writing, a thing of which I have never yet been 
guilty. So, to please you, I am going to write down some advice on 
the treatment of an epileptic boy. The layman will, of course, inevi- 
tably misunderstand the meaning and blunder as to the due measure 
or the right time of application, for we have shown in other writings 
that it is not possible, without a thorough study of the therapeutic 
method, to cure any of the smallest diseases, let alone such great ones 
as epilepsy. Dionysius has already communicated with me and 
together we considered the whole treatment of the boy, before you 
urged the writing of these instructions. I easily explained my opinion 
to him, for he is able to follow what one says without misunderstand- 
ing anything, since he is sufficiently trained in the therapeutic method. 

But I do not know how to go through the subject with you. For 
while that which is exact in it requires much elaboration and is too 
obscure for a layman, that which is concise and clear is, on the other 
hand, not exact. Thus I hesitated to write the instructions, much as 
I wished to please you. It seemed to me that I should suffer some- 
thing similar to what Phidias would have suffered if, after creating 
the statue of Athene, he had been compelled to create a finger, an 
arm, a foot, the nose, an ear, and each of the other parts all separately. 
For I think, like a statue, the "therapeutic method" 6 has been created 
by me in several books, not, however, in a manner likely to help the 
layman or even the ordinary physician. 

Since you, however, compel me to take one part of the medical art as 

6 Galen is obviously referring to the fourteen books of his dtpcnvtvTiKri nkdodos 
a systematic book on therapeutics. Cf. also Ilberg, I.e. 



galen's advice for epileptic boy 181 

my subject, separated from the harmonious union with the rest, I 
yield in obedience to the compulsion and write such instructions, as 
will be sufficient for you. For they suffice to prevent a layman, es- 
pecially one who has in the usual way learned to be conversant with 
such writings, from making grave and irreparable mistakes in what 
the physicians prescribe. For physicians the treatise on the "thera- 
peutic method" has been written; for you, however, and for the others 
who have a knowledge of some rational arts but are laymen in medi- 
cine, some advantage may nevertheless accrue, as I believe, from the 
present writing. 

II 

I shall try to go through as clearly as possible the manner of life by 
which the boy may benefit not a little and may suffer least harm from 
unexpected daily occurrences. These one must avoid as far as pos- 
sible. Sometimes, however, he will necessarily encounter frost and 
violent heat, strong winds and strenuous baths, repulsive food and 
whirling wheels, lightning and thunder, sleeplessness and indigestion, 
distress and anger and weariness and similar things of which the chief 
characteristic is that they stir up and trouble the body violently, re- 
mind it of the disease, and produce a paroxysm. It is necessary to 
avoid these carefully, and if ever they occur and a paroxysm follows, 
then the boy must abstain completely from any motion, he must stay 
at home, and be put on a very light diet until the body throws off the 
fatigue resulting from the attack. I think you know what light diet 
is, and in any case, you will hear something about it if you read 
through the following. For now it is time for me to begin the pre- 
scriptions. 

Ill 

My instructions are to purge the boy moderately when spring ap- 
proaches, for thus one may succeed in moving diseases caused by 
obstructions. Dionysius, who will be present, may take charge of 
it and regulate it. He knows exactly how to prepare the body for the 
purgation and what drug to use, and when; and he has already dis- 
cussed the question with me. Thus in Athens you will have Dionys- 
ius present in the flesh and, together with him, my spirit and opinion 



182 OWSEI TEMKIN 

too. But after the purgation, when Dionysius has gone and the boy- 
stays behind in Athens, you must put him on the following regimen : — 

On rising from bed at daybreak, he should walk about in moderation 
and not very strenuously before joining his teachers. From then 
until it is time for the palaestra, 7 he should devote himself to his 
accustomed studies. As soon as he is released from them, he should 
walk again, making his way to the master of exercises. This man, 
of all the people who take care of the boy, has to be very thoughtful. 
It is, however, not very easy to find such a man, since he must be 
chosen from amongst those who are quite uneducated and whose 
souls are as donkey-like and stout as their bodies. Now do not pass 
this over lightly and do not entrust the boy to the first person you 
meet ! You must have in mind that the main point of the treatment 
consists in these two things: the use of the drug I have given to you, 8 
and the exercises. All other things are a kind of preparation for 
these. But Dionysius may help you in the choice of the master of 
exercises. 

As regards the number of the exercises, the master must bear in mind 
to stop the boy before he becomes exhausted and, on the other hand, 
to make the whole body warm and adequately to rid it of superfluous 
substances. 9 But both demands should be fulfilled at the same time. 
For the moment that adequate excretion of the superfluous material 
has taken place the body has become sufficiently warm, and if at this 
moment the exercises are discontinued, one is just in time to prevent 
exhaustion. But exercises beyond this point affect the solid parts 
and melt down their shape ; and the molten matter is collected chiefly 
in the joints and muscles. From this there follows impairment of the 
strength and thereupon a feeling of soreness when one endeavours to 
move any limb; this condition is fatigue. Therefore, the master of 
exercises must be not only prudent, but also well versed in moderate 
exercises. He must neither stop the exercises earlier than necessary 

7 The place where gymnastics and sports were practised. 

8 Galen refers to the drug made from squills, the preparation of which is de- 
scribed in the last paragraph. 

9 p. 362 : Kevwaai. This is based on the conception that superfluous materials 
(t6 irtpiTTov or to. irepiTToinara) engendered by food, indigestion, etc. play a part 
in the origin of diseases and ought, therefore, to be driven out. 



GALEN'S advice for epileptic boy 183 

for fear of the following weariness, nor must he drive the boy to fatigue 
in the desire to warm the body and to rid it completely of all the super- 
fluous material. These are the chief points as regards the right 
number of exercises. 

As to their character, one must try to strengthen all members and 
particularly the head and the stomach, and of the latter especially the 
parts around the cardia. 10 Now I shall tell you how one may attain 
this end. First, since strenuous exercises make the head full, I 
prescribe abstinence from them. Second, if ever it were necessary 
to use them, the lower parts should be moved, in particular the legs, 
the head being raised straight up. Third, in these exercises the master 
should begin with small, slow movements and thus lead up to more 
violent and quicker ones. It is extremely noxious not for weak bodies 
only, but for strong ones too, immediately to enter upon vehement 
exercises. 

Believe me, too, rubbing is as good as exercise, especially for weaker 
bodies; and often the other drills are no longer necessary, if this alone 
has been administered properly. At first one must impart to the 
body a red appearance by rubbing downwards gently with muslin. 
One starts with the arms and hands, proceeds in the same way to the 
chest and abdomen, and then rubs the legs a little more in order to 
draw something from the upper parts of the body in this direction. 
Finally, one will attack the head, but it is dangerous to do so right at 
the beginning. For when the body is still full, the superfluous material 
is drawn to the part which is warmed first. Thus, as I have just said, 
the head must be rubbed last of all, when one does not use oil. But 
when one uses oil, there is no reason why one should not rub the head 
together with the other parts; so that one man may rub the head, two 
others the chest and the abdomen, and two others the legs. This 
method of rubbing all parts together should also be applied after the 
exercises and then especially, for thus the body sinks more quickly into 
repose and cools down less. If you pay attention to anything at all, 
you must do so to this. 

It is usually better not to bathe and not to leave the palaestra 
immediately after the exercises. Rather, when breathing has become 

"verbally: the mouth of the stomach. 



184 OWSEI TEMKIN 

calm and regular and when the excitement from the exercises has 
completely abated, one should rub the head energetically with the 
muslin and often even use the comb. 

IV 

After this the boy should go to lunch. Beforehand he should take 
something that evacuates the stomach; then he may eat some vege- 
tables, or salted fish, or barley-gruel, or olives, together with a third 
of his daily ration of bread, laying aside the two other parts with the 
more substantial food for dinner. I shall tell you later on which the 
heavier dishes are, when I have first gone through all those one may 
take without harm. 

As regards vegetables, I do not prescribe the avoidance of lettuce, 
or mallow, or orach, or blite altogether; but one should not always 
take the same, but rather eat moderately now of one, now of another. 
Beets and cabbage belong to the same category, for of these too one 
must partake moderately. It is wholesome to take a little leek and 
parsley and smyrnion 11 from time to time, and of tree-fruits those 
which are not entirely rough in nature and hard to digest. For such 
foods keep back their own superfluous materials as well as those of the 
other dishes. Black mulberries and the so-called "praecoccia" 12 and 
figs, and whatever is similar to these, pass through without causing 
harm; the so-called gourd is not inferior to any of the mildest vegeta- 
bles, and the same is true of the melons too, whereas unripe cucumber 
is bad. 

From time to time one must also allow the boy to take a bunch of 
ripe grapes, whereas he should seldom be given apples and pears and 
then very little, and they must have ripened well not only on the tree, 
but at home too after gathering. For, concerning tree-fruits suitable 
for storage, one ought to know that fresh ones are quite different from 

11 According to J. Berendes, Des Pedanios Dioskurides aus Anazarbos Arznei- 
mittellehre in fiinf Biichern, Stuttgart 1902, p. 308 the afivpvLov is Smyrnium 
perfoliatum L. It is not always possible to identify the plants given by Galen 
with absolute certainty. 

a p. 366: ro 7rpai(c6/c/cia nakovneva. Heller, I.e. p. 600 interprets them as 
"fruhreife Gewachse," I think rightly. It is probably a Greek rendering of the 
Latin "praecocia" derived from praecox. 



galen's advice for epileptic boy 185 

old ones. Now one can store apples and pears and most tree-fruits, 
the so-called Damascus plums, and dried figs. Dates belong to the 
same category; I do not exclude them completely but they must be 
taken at the right time and in moderation. 

Speaking generally, I recommend abstinence from daily or immod- 
erate use of such food as engenders unhealthy humours, or as causes 
constipation or flatulence and is hard to digest. Such food, if taken 
constantly or more than is advisable at a time, usually causes harm 
not in this disease only but in all other diseases too. 

Thus far the dietetic remarks would be equally valid for many other 
diseases; it is, however, peculiar and special to this disease that one 
must chiefly beware of food which engenders phlegmatic humours. 
Therefore, it is not good to partake habitually of things which, al- 
though harmless otherwise, have a viscous or cold or thick juice, such 
as orach, blite and mallow, and although I do not exclude them, I do 
not wish them to be eaten always. Gourds belong to the same cate- 
gory and cucumber, apples and pears even more so, and finally the 
so-called mushrooms, the worst of all foods with a phlegmatic, thick 
and viscous juice. From these I advise complete abstinence, just as 
from turnips and all other things with an edible root. For they have a 
thick juice and are on the whole hard to digest, except if they contain 
something sharp and warm, like parsnips and radish. The boy may 
taste radish from time to time, but he should try to abstain from 
parsnips and especially from turnips. He may have plenty of such 
food as contains something sharp and pungent, and which does not 
obviously engender bad humours nor has a smell which might affect 
the head. Those things, however, which by their heat make the head 
full, such as wine, mustard, parsley, parsnips, onions and smyrnion, 
belong to this class of exceptions. They overheat and engender 
unwholesome humours. Mustard, although very apt to separate the 
humours, must be avoided since it affects the head. 

The boy should take vinegar-honey 13 with all confidence, even every 
day if he wants it. Capers can be taken with it and some salted fish, 
adding a little olive oil of course, as much as is necessary to make the 
dish pleasant. This dish is a kind of remedy for the disease, partic- 

13 The preparation is described in the last paragraph. 



186 OWSEI TEMKIN 

ularly if the vinegar has been prepared with squills, in which case 
people usually call it "scilleticon." Above all, I want him to take 
one of these two things each day, I mean to say, caper or salted fish 
with vinegar-honey. If, however, the boy also wants to drink vinegar- 
honey, it should be prepared beforehand (you will soon read how it has 
to be prepared) and not be mixed on the spur of the moment from the 
unmellowed ingredients. And it must be mixed with plenty of water, 
for in this way it becomes more pleasant. In winter it must be taken 
warm; in summer, however, nothing stands in the way of often using 
it cold, if the heat is excessive, the thirst great, and if the person is not 
entirely unaccustomed to cold beverages. For besides everything else, 
vinegar-honey, if not too sweet, quenches the thirst very well, and 
even better if it is mixed with cold water. To complete the cure of an 
epileptic boy, after the first purgation, it often sufficed if I prescribed 
the vinegar-honey and the use of the drug, without altering anything 
else in his old manner of life. But since I am not familiar with your 
son's constitution and am not going to take charge of him personally, 
and since I do not know how bad the disease is, I cannot predict how 
few remedies he may need and it seems better to me to discuss them all. 
Thus, as I have said, after the exercises he should partake at lunch 
of vinegar-honey and eat some vegetables, olives, nuts, figs and dried 
figs — but not all of them together every day. He should rather take 
one simple dish; but I mention all of them, so that the diet may be 
varied. At this time, as has been said, the boy may also partake of the 
other tree-fruits, if he craves them. But otherwise it would be better 
to abstain from them, not only for the sake of curing the disease, but 
also in consideration of the whole state of health, as you see us too 
abstaining strictly from all seasonable food. But, it is true, we do not 
write about a healthy regimen for philosophers, as I should like best 
to do, nor, on the other hand, do we write merely for the cure of the 
disease, but also concerning the whole life of your boy. Now one 
must permit him to eat openly and at the right time things which do 
not cause great harm, lest he be harmed more by taking them secretly 
and at the wrong time. For people who are prevented from doing so 
openly, fill themselves with what they desire all at once and in a larger 
quantity. I prefer to concede to children many such foods as, al- 
though not beneficial, do not do much harm if eaten openly and at the 



GALEN 'S ADVICE FOR EPILEPTIC BOY 187 

right time and with the necessary moderation, lest at the wrong time 
they might be compelled by the vehement desire to eat more and 
greedily. This should be the arrangement regarding the food. 



After this the boy should have a short intermission and then I want 
him to walk about leisurely before resuming his studies. And after 
being released from these, I should like him to walk about again before 
dinner. Then he should eat the two parts of bread which were left, 
and of the other things according to the instructions. He may eat the 
meat of almost all birds except water-fowl. Above all, he must ab- 
stain from eating quadrupeds, but if at some time it be necessary to 
partake of them, he may eat the stomach of the domestic pig and 
such parts as are not fleshy, while of the wild pig he may eat the 
fleshy parts too. He may also have a taste of kid and hare. All 
these should be prepared simply or roasted without fat; "simply" 
means by way of water seasoned with dill, leek, oil and salt. You 
have seen at my house the earthen vessel in which to roast meat well 
without fat. 

As regards sea-food, oysters are all bad; among fish, those living 
near the rocks are the best of all, but it will also be necessary to par- 
take of those living in the open sea. The ray is almost the only carti- 
laginous fish which is suitable. 14 Among the plants with hulls, 16 
husked barley stands first, lentils, wheat-groats and peas come next, 
while the others are bad. Generally speaking one must beware, as 
has been said before, of everything which causes viscous and thick 
humours, and flatulence and engenders superfluous substances and is 

14 p. 373: v va.pia) 81 [ihvt\ cx^° v Tt ™ v iiotKaKiuiv ewirriliaos. Dr. Edel- 
stein was good enough to compare this passage with two manuscripts of the 
writing preserved in Rome. Although they confirm the reading given by Kiihn, 
I have translated "cartilaginous fish" instead of tuv naXaaLuiv. The Latin 
translation also renders this sentence as : Ex cartilagineo autem torpedo fere sola 
convenit. Aristotle (Hist, animal, 540b) numbers the ray amongst the selachia. 
A passage with Athenaeus, Deipnosophistae VII (314 d) proves that the ray 
was actually eaten in antiquity. 

15 p 373: 6(?TpL<j>v ol irTioavri etc. oo-n-pia means leguminous plants, but since 
barley does not belong to them, Galen seems to have used the term in a broader 
sense different from that given by Theophrastus, Hist, plant. 8, 1. 



188 OWSEI TEMKJN 

hard to digest. Oysters, cartilaginous fish, bulbous roots, snails, 
cheese, mushrooms, beef and boiled eggs are hard to digest and thicken 
the humours of those who eat them. Wheat-groats and pork engender 
good but viscous blood. All water-fowl, however, engender super- 
fluous substances, while plants with hulls, especially beans and chick- 
peas, cause flatulence. Husked barley too, if not boiled diligently, 
causes flatulence, so that one must either boil it or not use it. If 
lentils are well boiled, the whole flatulent element is thrown off — but 
it is not good to take too much of them, since they engender a thick 
humour. These instructions are sufficient for the daily diet. 

VI 

After the purgation which I ordered to take place at the beginning 
of the spring, your son should use the drug prepared from squills which 
I gave to you. He should use it every day before leaving for the pa- 
laestra, and if the disease is not very severe and hardened, it may be 
hoped that it will cede completely in forty days through this drug; 
indeed I have cured innumerable children in this way without having 
to use hellebore. But it is necessary to drink wormwood once or 
twice after the purgation and before using the drug. 

The sharpest vinegar-honey contains one part of vinegar to four of 
honey and the sweetest, one part to eight. The intervening degrees 
are determined in sharpness or sweetness by their proximity to one 
of the two extremes. But it must be boiled thoroughly, for thus both 
ingredients are properly united: the pungency of the vinegar is re- 
fined and the flatulent power in the honey is checked. The person 
who boils it must remove the foam completely. I know that in Greece 
and in most of the islands vinegar-honey is also prepared from honey- 
comb, and you may confidently use this kind too, especially in summer 
when the boy resides in Athens. However, it is not my business to 
determine at what time one ought to give it sweeter or sharper, with 
more or less water, and many other details. This rather is the concern 
of the man who is present and who sees the body under treatment, and 
is able to judge the condition of the humours. For with thick and 
viscous humours, one must use the vinegar-honey sharper and less 
mingled with water; otherwise, one must use it with more water and 
sweeter. In the same way, it is necessary to change and vary every- 



galen's advice for epileptic boy 189 

thing else which has been mentioned, according to the daily condition 
of the body, as in all other diseases too. Wherefore, even if one wrote 
innumerable prescriptions for a man who is not exercised in the thera- 
peutic method and hence skillful, one would not make him a capable 
physician, not even for one of the smallest diseases, let alone of the 
greatest! I have often shown this clearly by healing chronic ulcers 
and diseases of the eye with the same drugs as physicians had used 
before without success. According to Hippocrates, when the quan- 
tity of each drug has been determined according to its potency, the 
rest of the cure consists in its administration at the right time. And, 
as all the best physicians have agreed, the drugs are rather the means 
of assistance than assistance itself. Thus I finish the subject where I 
began it : the layman cannot handle the least thing well but needs the 
supervision of the expert. 

Since, however, most people extract the juice of the squill badly, 
and since you wish to learn how I do it, I am going to add to this work the 
manner of its preparation. I take the honey vessel, as the Greeks call 
them, from which the honey has been emptied and I put in squills after 
having rubbed them into fine pieces between my hands. I cover it with 
a close-fitting lid and put a skin around the whole body of the vessel, 
fastening it carefully. Then I put it in a place facing the south and 
sheltered from the north winds, so that they cannot blow upon it. I 
do this at the time of the year believed by all Greeks to be the season of 
the rising of the dog-star. This season has forty days; twenty before 
the rising itself and the same number of days afterwards. During 
this period I sometimes gently change the position of the pot in order 
to get it warm on each side alike. At the end of this time, I unfasten 
it and then I find that the body of the squills looks as though it had 
been boiled in the vessel and some of the juice has come out. I take 
out the juice and sweetening it with the best honey, I administer one 
spoonful of it daily; a small one to children and a large one to adults. 
I also cut the body of the whole squills fine and, levigating it with 
honey, I give a spoonful of this too in the manner described. You 
must know that its potency is second to that of the above-mentioned 
iuice But those who boil the squills in water make them lose their 
potency, while those who prepare them with vinegar make the drug 
very strong but not harmless for the nerves. 



Date Due 



— 



MMt 



- m > >** 



1H 



m 



wc&t 



y 



sra¥ 



Demco 293-5 



Accession no. 

ACK 

Author 

Temkin,0. Galen's 
"Advice for an 
epileptic boy". 

Call no. 

R126 

gUp5t 








V 



A 



0vs$3 


fir* JL JJl* JkL. IBr* 






vs«hI 






V 



fe 






A